Quality Improvement Survey-Organ

Arkansas Regional Organ Recovery Agency: Quality Improvement Survey

The following survey is designed to gain information about how we can improve our service. Your feedback is very important to us.

* Date

* Donor Name

* Recovery Date

* Hospital Name

* Role in the Organ Recovery Process?

OR Staff Member

ICU Staff Member

Physician

Arkansas Regional Organ Recovery Agency: Quality Improvement Survey Physician

Role or Title in the organ recovery process (For example: pronouncing MD, Cardiologist, Surgeon, Anesthesiologist, etc.)?

Please rate the following aspects of ARORA's service.

	Totally agree	Somewhat agree	Neutral	Somewhat disagree	Totally disagree
The ARORA Coordinator Coordinator explained who they were and their role.
The ARORA Coordinator conducted him/herself in a professional manner.
The ARORA Coordinator was able to provide you with any additional information you needed.
The ARORA Coordinator clearly explained why they were contacting you for your assistance.
The ARORA Coordinator assisted you at the bedside with any procedures you may have performed.
F. I am comfortable assisting with organ donors within my scope of practice.

Additional Comments:

How many organ donor have you been involved with?

Did you recieve follow-up information after the organ recovery?

Arkansas Regional Organ Recovery Agency: Quality Improvement Survey-ICU

Please rate the following aspects of ARORA's service.

Did the ARORA personnel:

	Yes	No	Not Observed
Respond to your initial telephone referral in a timely manner?
Arrive at your hospital/unit in a satisfactory amount of time?
Request appropriate information and accept the donor in a timely manner?
Conduct themselves in a professional manner?
Introduce other coordinators, surgeons, and assistants as appropriate?
Treat the donor with respect?
Assist with procedures at the bedside?
Communicate clearly?

Could the organ recovery process be improved?

Yes

No

Additional Comments:

If yes, please explain

How many organ recoveries have you participated in?

Did you recieve follow-up information after the organ recovery?

Arkansas Regional Organ Recovery Agency: Quality Improvement Survey-OR

Please rate the following aspects of ARORA's service.

Did the ARORA personnel:

	Yes	No	Not Observed
Give you a time to set up the OR for the recovery process?
Give you information about the organs/tissues being recovered?
Conduct themselves in a professional manner?
Introduce the visiting recovery team?
Maintain sterile technique?
Treat the donor with respect?

Did the visiting surgical teams:

Additional Comments:

Could the organ recovery process be improved?

Yes

No

If yes, please explain

How many organ recoveries have you participated in?

Did you recieve follow-up information after the organ recovery?

* Indicates Response Required